Eat more vegetables. Reduce your sugar. Switch to whole grains.
The guidelines, which will be published later this year, dictate federal nutrition policies and form the basis for governmental food assistance programs and nutrition education efforts. But communities of color say the recommendations and the current guidelines are insensitive, largely unreachable, and even irrelevant to the nation’s major racial, ethnic, and cultural groups. They point out that the committee of scientists is mostly white and many of the studies it analyzed don’t reflect the nation’s growing diversity. Such considerations are especially important now, as many of these populations are at elevated risk for COVID-19.
“They’re missing the ball,” said Daphene Altema-Johnson, the food communities and public health program officer at Johns Hopkins University’s Center for a Livable Future. “We know what’s optimal. We also know that chronic diseases affect people of color at a disproportionate rate. Yet there has been no improvement because we’ve done nothing to address the root cause of these health disparities.”
Instead of a one-size-fits-all approach, Altema-Johnson and other advocates want to see the guidelines—and the science-based recommendations that shape them—evolve to address the systemic impacts of racism on nutrition, including food insecurity, the lack of access to healthy foods, and the needs of people with chronic diseases. Advocates also want to see the messaging around the guidelines to include foods that are culturally relevant across different racial and ethnic groups.
“We know that chronic diseases affect people of color at a disproportionate rate. Yet there has been no improvement because we’ve done nothing to address the root cause of these health disparities.”
“Right now, the Dietary Guidelines are not for everyone,” Altema-Johnson said. “Our people are dying because they’re not getting the right nutrition. You can’t make recommendations unless you make adjustments so that the guidelines are accessible to all Americans.”
The Dietary Guidelines for Americans, published every five years since 1980, provide science-based advice to promote health and to reduce the risk for major chronic diseases. They don’t offer specific tips or tailored approaches for people who are already struggling with obesity, diabetes, or other chronic diseases, which critics say prevent a significant number of people from using them.
“It makes them less relevant to populations that have health disparities, which is a large number of people. It puts these populations at a disadvantage . . . it seems unfair,” said Norah Deluhery, coordinator of The Food4Health Alliance, a group that’s pushing for the guidelines for be more inclusive of Americans from disadvantaged minority groups and those with chronic diseases.
Critics say The Food4Health Alliance is using the focus on structural racism to undermine the guidelines’ scientific process. According to the Union of Concerned Scientists (UCS) and other groups, the Food4Health Alliance was founded in part by the Nutrition Coalition, an organization that is controversial for promoting low-carb, high fat diets and has worked to discredit some of the guidelines’ science-based recommendations. This week, over 200 members of the Academy of Nutrition and Dietetics signed a letter asking the Academy to severe ties with the Nutrition Coalition. The letter does not discount the urgent need to address the root causes of diet-related health disparities and stresses the need to find new mechanisms to address these disparities, UCS’s Sarah Reinhardt said.
“This is absolutely an issue of racial equity, and it’s something we desperately need to address,” said Reinhardt. “But dietary guidance isn’t failing us because we lack a rigorous process for developing it. It’s because the federal government spends next to nothing on needed nutrition research, and even less than that on implementing its own recommendations.”
The guidelines form the basis for myriad food assistance programs that are relied upon by low-income Black and Indigenous people as well other people of color (commonly referred to as BIPOC). These include the National School Lunch Program, the Elderly Nutrition Program, the Food Distribution Program on Indian Reservations, and the Supplemental Nutrition Assistance Program (SNAP, as well as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Little research exists on whether food assistance programs are helping to bridge nutrition gaps, but one recent study suggests that SNAP may not be meeting its potential to alleviate disparities between white and Black households. Another study finds that SNAP participation is not associated with improvements in dietary quality or lower weight status among most Black and Latinx households experiencing food insecurity.
A recent study suggests that SNAP may not be meeting its potential to alleviate disparities between white and Black households.
“It’s critical that the guidelines take into account the needs of the population they serve,” Deluhery said.
But that’s not what the guidelines are meant to do, according to a spokesperson for the U.S. Department of Agriculture (USDA), which oversees the guidelines. “They are written for nutrition policymakers and health professionals and intended to be generalizable to the American population at large. . . . It is beyond the scope of the Dietary Guidelines to be tailored to specific groups or treat specific diseases,” wrote the spokesperson in a recent email. However, the spokesperson added, many government agencies, nonprofits, medical professionals, and health organizations build on the dietary guidelines to provide nutrition guidance tailored to a particular group’s needs or treat specific medical conditions and illnesses.
Another issue, Deluhery said, is that the majority of the research the advisory committee consults is based on white, middle class subjects. The committee, whose report will help the USDA and the Department of Health and Human Services to develop the new version of the guidelines, was presented with nearly 1,500 primary research articles, 16 existing systematic reviews, more than 50 analyses of federal data sets, and numerous food pattern modeling analyses.
But it should also have evaluated more research on the differences in the nutritional needs of non-white Americans, such as studies looking at Vitamin D absorption among African Americans, said Deluhery. The USDA declined to say how much of the research looked at specific ethnic and racial groups. The committee’s report suggests federal agencies should ensure national surveillance systems to expand the diversity and sample size of underreported populations
Despite America’s shifting population, the recommendations have changed little over the years. They recommend that eaters fill half their plate with fruit and vegetables, eat at least 50 percent whole grains, and choose low-fat dairy, among other things. While the committee this month recommended a small reduction in added sugar, most Americans don’t even reach the current limit.
The recommendations also have expanded to include dietary guidance for infants and toddlers, as well as pregnant and breastfeeding women. They continue to focus on dietary patterns—how foods are consumed in various combinations over time. The dietary pattern approach, according to the report, allows people to use food combinations that are both healthy and take into account cultural and culinary preferences. But the recommendations do not give specific examples of patterns for minority subgroups.
Despite America’s shifting population, the recommendations have changed little over the years. Another thing that hasn’t changed: Most Americans don’t follow the guidelines.
Another thing that hasn’t changed: Most Americans don’t follow the guidelines. In 2015, for instance, only 9 percent of Americans ate the recommended amount of vegetables. As a result, diet-related disease such as type 2 diabetes, heart disease, and cancer are the leading causes of death in the U.S. Six in 10 adults have a chronic disease and 4 in 10 have two or more disease conditions, according to the Centers for Disease Control and Prevention (CDC).
The statistics are worse for people of color. Black people have higher rates of diabetes, hypertension, and obesity than whites—all risk factors for heart disease, stroke, and death. Diabetes is also one of the most common chronic diseases among Native Americans and Latinx populations.
People of color are also disproportionately impacted by COVID-19 as a result of such chronic conditions and are at increased risk of experiencing severe illness, hospitalization, and death when infected with the virus. Native Americans and Black Americans have a hospitalization rate approximately five times that of white Americans, while for Latinx people it is four times higher—and diet-related illnesses often put them at greater risk.
The advisory committee, which reviews scientific evidence on topics and questions specifically identified by federal agencies, does acknowledge that COVID-19 has “significant nutritional implications” and “those at most risk for the most serious outcomes of COVID-19 are people afflicted by diet-related chronic diseases.” It also mentions in passing the significant presence of food insecurity and the high cost of many healthy foods and both factors’ impact on the rise of chronic diseases.
But the report states simply that “these relationships should be further examined in future Dietary Guidelines” and suggests it’s up to the federal agencies to address those issues “through appropriate mechanisms.” The report all but ignores the racial and ethnic disparities the pandemic has brought to light.
This is a glaring problem, said Altema-Johnson, because the recommendations are simply unattainable for many Black and brown Americans. In addition, she wants to see the guidelines lead to more research on health disparities and address systemic racism, food insecurity and equity, and identify new policies to improve access.
“When I ask a child in the inner city what type of fruits and veggies he likes, the child says, ‘I don’t eat fruits and vegetables. I eat bananas from 7-11 and fruit cups at school,'” said Altema-Johnson.
One of the reasons that the Dietary Guidelines—and the food assistance programs they influence—are not making much of a dent in improving the health of communities of color may be the fact that they don’t reflect those communities, said Constance Brown-Riggs, a registered dietitian and certified diabetes educator based in New York City.
“The guidelines are culturally insensitive and not practical in many people’s lives. They are not relevant to our community,” said Brown-Riggs.
When Black people read the guidelines or look at the MyPlate guide designed to make them more accessible, she said, “there’s nothing there that resonates.” These resources lack both the foods that are familiar to the Black community as well as information on what to eat when you have diabetes or another chronic condition. Federal agencies could easily adapt MyPlate—which shows food group targets and what and how much to eat within a specific, personalized calorie allowance—to include culturally specific versions for different racial and ethnic groups, said Brown-Riggs, instead of just translating the information into several languages.
As the author of The African American Guide To Living Well With Diabetes, Brown-Riggs has developed her own soul food and Afro-Caribbean-inspired visual guide, in which foods are categorized based on their carbohydrate content (since carbs most significantly impact blood sugar levels). It lists callaloo (a Caribbean green), okra, dandelion greens, collard greens, and cabbage in the vegetables category and catfish, hog maws, goat, and pig’s ears as proteins. Chitterlings, the fried intestines of a hog, are listed in the fat category. Sweet potatoes, cornbread, biscuits, grits, black eyed peas, and pinto beans form the starch group—a category of its own because starch can lead to spikes in blood sugar levels. The USDA, categorizes beans and legumes as either vegetables or “protein foods.”
“If Black people can understand how traditional foods fit in with MyPlate, it will help them get the nutrients they need.”
“These are the foods our people eat. They have a connection to them,” Brown-Riggs said. “Some have never had asparagus or broccoli, but collard greens and okra are good vegetables, too. If Black people can understand how traditional foods fit in with MyPlate, it will help them get the nutrients they need.”
Having a MyPlate experience customized to the Black community is crucial, Brown-Riggs said, because many white doctors and nurses don’t have the knowledge to make nutritional advice that’s culturally relevant. As a result, they give patients general advice to eat from certain groups and “they wonder why their patients don’t follow through,” she said.
The cost of fresh food is also a big barrier, said Ann M. Cheney, assistant professor in the Department of Social Medicine, Population, and Public Health at the U.C. Riverside School of Medicine.
“A lot of how we think about nutrition and lifestyle is based on a dominant model of a middle class, white, nuclear family,” Cheney said. “It’s really difficult for low- income Latinos to eat in a healthy way or make the lifestyle choices that are recommended.”
Cheney is leading a new project to help diabetic and prediabetic Latinx people in Southern California’s Coachella Valley access MyPlate recipes and incorporate them into their daily meals. It’s a tall order. Fruits and vegetables are often expensive or unavailable in the areas where they live, putting them out of reach even to the farmworkers who harvest them. Instead, low-income Latinx folks tend to shop in convenience stores, corner bodegas, or at gas stations, Cheney said.
People in rural communities also have limited access to government food programs. And where such programs exist, the lack of public transportation, nonflexible work schedules, impede access. And when low-income Latinx people do receive produce and other healthier products from food banks, the recipes accompanying the food are in typically English and feature an typical Anglo diet.
In Cheney’s current project, she’s identifying ways to improve MyPlate recipes for this audience. Federal agencies also need to reassess their messaging around the Dietary Guidelines and MyPlate, she said. “They give you stuff to read, they say it’s based on research and studies, and the evidence shows this is how you should eat,” she said. “But a lot of people don’t absorb information like this.”
She adds that the culturally appropriate messaging could include squash and tomatillos instead of lettuce, which is often seen as inaccessible due to cost in Latinx households. And instead of wheat, they could recommend whole-grain corn, a cultural staple. Cheney points to Mexico’s Plato Del Buen Comer as a more visually rich way to share nutrition information.
Among those who are Latinx, storytelling is an important way to share information, she said. “It’s talking about nutrition . . . in a lived-experience way,” she said. For this reason, it helps to use characters in a cookbooks, radio novelas, and popular education.
The current model of nutrition promoted by the Dietary Guidelines is also based on the idea of eating as an individual, making it irrelevant to the family-oriented Latinx culture and to people who live with multiple generations in one household.
The current model of nutrition promoted by the Dietary Guidelines is also based on the idea of eating as an individual, making it irrelevant to the family-oriented Latinx culture and to people who live with multiple generations in one household. “This idea of your diet being an independent choice doesn’t speak to many Latinos,” Cheney said. “They don’t make any decisions, including what to eat, without taking everyone else into account.”
For now, translating the Dietary Guidelines into something that the Latinx population can understand falls to people like Angel Garcia, a health educator with Borrego Health, the largest community health center network in California. Key to his approach is seeing clients frequently, which helps establish a more trusting, communicative relationship.
Garcia, who mainly works with diabetics and pre-diabetics, said many Latinx families still follow tradition when it comes to their diets. And as such, their diets are very high on carbohydrates such as tortillas, rice, corn, and very limited on vegetables, he said. Lard is a commonly used fat.
“My job is to help them continue with their tradition, but also to make some dietary changes,” said Garcia. He promotes traditional vegetables such as nopales, or cactus, which can help lower blood glucose levels. It’s not just about adding vegetables, he said, but also using more whole grain products, leaner meats, healthier fats, and eating smaller portions of fruit. And because carbohydrates impact blood sugar levels, the guidelines and MyPlate don’t work for many. Garcia recommends his clients limit portions of fruits and starchy foods such as corn and eat more non-starchy veggies like peppers and broccoli.
Many Native American communities also feel excluded from the current Dietary Guidelines, said Valerie Segrest, regional director of the Native Food & Knowledge Systems at the Native American Agriculture Fund. Because the guidelines are aimed at nourishing healthy people, she says they often make little sense given the epidemic of diabetes, cancer, heart disease, and asthma in Indian Country.
Segrest, an enrolled member of the Muckleshoot Indian Tribe in Washington state, said the federal government needs to do more to help people access nutrient-dense foods. She points to the method used by WIC, which heavily promotes the importance of folic acid for pregnant women because a lack of this vitamin leads to brain and spinal birth defects. Similarly, she says other nutrients should be promoted to prevent chronic illness.
Another approach, Segrest said, is to encourage Indigenous people to become food producers, on both a small and large scale, and to return to their traditional diets. And while fishing and hunting isn’t realistic for everyone, some tribal governments have begun to promote a return the ancestral diet. Such an approach is much more nutrient-dense than many of the foods mentioned in the MyPlate marketing, she added, because it includes traditional proteins with healthy fats like salmon, deer, elk, and oysters, fruit like huckleberries and other wild berries, seeds like sunflower and pumpkin, and dandelion greens, squash, tomatoes, and traditional corn varieties.
“The remedies are around us, everywhere,” said Segrest. “Our elders told us, ‘You have to create a way for people to go grocery shopping and bring their ancestors with them,’” Segrest said. “What would our ancestors recognize as food?”
Martin Reinhardt has been working to figure out just what it would take to eat an ancestral diet in modern times. An associate professor of Native American Studies at Northern Michigan University and an Anishinaabe Ojibwe, Reinhardt said it’s frustrating that the Dietary Guidelines don’t acknowledge or recommend traditional tribal foods.
“To know these foods are not important enough to the community of scholars that’s putting forward these guidelines is illustrative of the way they feel about Indigenous people,” Reinhardt said. “They don’t see us as part of the core.”
It’s not just a symbolic slight. Reinhardt’s research shows that traditional foods can significantly improve the health of Native American people who have been battered by diabetes and other chronic illnesses. The Decolonizing Diet Project he spearheaded in the Great Lakes region looked at research subjects who ate foods that grew or could be hunted in the region before Europeans came to the Americas—including wild rice, cranberries, fish, venison, corn, beans, squash, and maple syrup—for one whole year.
He found that the diet led to a significant decrease in weight, decrease in “bad cholesterol” and triglycerides, and lowered blood glucose levels, as well as raised vitamin levels.
“It proved that eating Indigenous foods could achieve great health outcomes, which our community badly needs,” Reinhardt said. “These foods are something we’ve had for thousands of years. They were our relatives. They sustained our ancestors and helped them thrive.”
The Native American food system was upended with the arrival of white settlers, he said. Tribes were removed from their lands—and their food sources. Those on reservations were often fed unhealthy government food rations. Indian children were enrolled in boarding schools, where they were fed a white man’s diet.
“Our people were forced into a relationship with flour, sugar, salt, and lard,” Reinhardt said. “We have a lot of scars and a lot of them are food-related. It’s no wonder so many [Indigenous people] today are struggling.”
The Dietary Guidelines could play an important role in reversing these patterns, he said, given that they’re taught in school and used by physicians and dietitians across the country. And promoting local, traditional foods would be a good start; Canada recently adopted an Indigenous food guide that includes traditional foods.
And while Reinhardt is focused on Native American communities, his vision of culturally specific foods applies to everyone who has been marginalized by the guidelines. Another important step would be to fund more studies that look at traditional dietary patterns and the impacts of such nutrition, and improve education efforts around ancestral diets. Funding programs that promote traditional local diets, and opening up more public spaces for growing healthy food could help make it possible for more Americans to eat a balanced diet.
“We need to revitalize the relationship between ourselves and our healthy food relatives,” he said.
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